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Got Shoulder Pain?

Shoulder pain is reported to occur in up to 20% of the general population, with 40% persisting for at least 1 year (Annual cost is about $39 billion)

Shoulder impingement is the most prevalent diagnosis, followed by traumatic injuries

Altered mechanics at the shoulder joint make it susceptible to degenerative changes

Degenerative changes can further alter posture and kinematics locally and at neighboring joints, due to muscle imbalances, joint dysfunction and movement compensations/impairments

Review of Shoulder Functional Anatomy

The shoulder is a unique joint that requires mobility and stability though the interplay of dynamic and static structures.

Stability is derived from muscles, whereas mobility is permitted from the relatively loose capsule and ligamentous structures.

Bones and Joints

The shoulder girdle is made up of articulations between the:

Humerus (arm bone)

Scapula (shoulder blade)

Clavicle (collar bone)

Sternum (breast bone)

Ribs

The are 4 primary joints that make up the shoulder:

Glenohumeral

Acromioclavicular

Sternoclavicular

Scapulothoracic

It is also important to note that because of the attachments of the latissimus dorsi muscle to both the shoulder locally and to the lumbo-pelvic-hip complex (LPHC) distally, that dysfunction in the LPHC can affect proper shoulder function.

There are a number of muscles associated with the shoulder joint:

Rotator Cuff/Local Muscles

Other muscles

Supraspinatus

Subscapularus

Infraspinatus

Teres major and minor

Deltoid

Pectoralis muscles

Latissimus dorsi

Rhomboids

Trapezius

Levator scapulae

Serratus

The rotator cuff muscles act primarily as a steering mechanism. Both the rotator cuff and other muscles provide static and dynamic stability.

Common Injuries Associated with the Shoulder Injuries:

Local

Injuries Above The Shoulder *

Injuries Below The Shoulder *

Rotator cuff strains

Shoulder impingement

Tendinopathies of the rotator cuff and biceps tendon (75-80% of shoulder injuries)

Instability

Cervical spine injuries

Headaches

Low back pain

SI joint dysfunction

Hamstring, quadricep and groin strains

IT- Band syndrome

Plantar Fasciitis

Achilles Tendinitis

*The neighboring joints above and below the shoulder are interconnected through the Kinetic Chain. These areas should be considered in the assessment and treatment process for shoulder conditions.

Other than obvious trauma through contact or strain, many shoulder injuries are due to a combination of:

The Upper Crossed Syndrome (UCS) was first described by the Czech physician Janda. The UCS is also referred to as proximal or shoulder girdle crossed syndrome.

In UCS, tightness of the upper trapezius and levator scapula on the dorsal (back) side crosses with tightness of the pectoralis major and minor on the anterior (front) side. Weakness of the deep cervical flexors ventrally (front) crosses with weakness of the middle and lower trapezius (Back). This pattern of imbalance creates joint dysfunction, particularly at C1-C2, C4-C5 segments, cervicothoracic joint, glenohumeral joint, and T4-T5 segments.

Specific postural changes are seen in UCS, including forward head posture, increased cervical lordosis and thoracic kyphosis, elevated and protracted shoulders, and rotation or abduction and winging of the scapulae.

These postural changes also decrease glenohumeral stability and result in winging of the scapulae.

In addition, this loss of stability results in compensatory tightening of the levator scapula and upper trapezius to maintain glenohumeral centration (optimal joint position).